Outcomes of jigsaw technique in nurse education: A systematic review and meta-analysis.

AIM: To determine the effect of Jigsaw technique in nursing education by meta-analysis method. BACKGROUND: Innovative methods actively engage students in the learning process, contrasting with the traditional memorization-based methods. Jigsaw technique, as one of these approaches, allows students to collaborate in small groups with the aim of accomplishing a shared learning objective. DESIGN: A meta-analysis of observational studies. DATA SOURCES: Google Scholar, Science Direct, Pubmed, Web of Science, ProQuest, Medline, CINAHL and Cochrane Library electronic databases in English was systematically searched from inception from January 2011 to December 2022. METHOD: This review used the preferred reporting items for meta-analyses (PRISMA) guidelines. The Cochrane Risk-of-Bias (RoB) Tool was used to assess the methodological quality of the included studies. Statistical analysis was conducted with the Comprehensive Meta Analysis (CMA) software. RESULTS: In the study, 11 studies from 6 different countries were examined. It has been determined that the Jigsaw learning technique in nursing students is a method that enables students to increase their academic success compared with traditional learning methods. In addition, it has been determined because of studies that Jigsaw learning technique is effective in students; interpersonal relations, critical thinking, communication and clinical skills, as well as increasing motivation, self-concept and attitudes such as self-confidence. Funnel plot, Classic Fail-Safe N, Begg-Mazumdar Rank tests showed no publication bias. CONCLUSION: As a result of the meta-analysis, it was determined that the Jigsaw technique had a positive effect on the academic achievement, skills and attitudes of nursing students.

Clinical assessment and short-term mortality prediction of older adults with altered mental status using RASS and 4AT tools.

BACKGROUND: Altered mental status (AMS) in older adults is a common reason for admission to emergency departments (EDs) and usually results from delirium, stupor, or coma. It is important to proficiently identify underlying factors and anticipate clinical outcomes for those patients. AIM: The primary objective of this study was to reveal and compare the clinical outcomes and etiologic factors of older patients with delirium, stupor, and coma. The secondary objective was to identify the 30-day mortality risk for those patients. METHOD: The study was conducted as prospective and observational research. We included patients aged 65 years and older who presented with new-onset neurological and cognitive symptoms or worsening in baseline mental status. Patients who presented no change in their baseline mental status within 48 h and those who needed urgent interventions were excluded. Selected patients were assessed using RASS and 4AT tools and classified into three groups: stupor/coma, delirium, and no stupor/coma or delirium (no-SCD). Appropriate statistical tests were applied to compare these 3 groups. The 30-day mortality risks were identified by Cox survival analysis and Kaplan-Meier curve. RESULTS: A total of 236 patients were eligible for the study. Based on their RASS and 4AT test scores: 56 (23.7%), 94 (40.6%), and 86 (36.4%) patients formed the stupor/coma, delirium and no-SCD groups, respectively. There was no statistical difference in the three groups for gender, mean age, and medical comorbidities. Neurological (34.7%), infectious (19.4%), and respiratory (19.0%) diseases were the leading factors for AMS. Post-hoc tests showed that CCI scores of the delirium (6, IQR = 3) and stupor/coma (7, IQR = 3) groups were not significantly different. The 30-day mortality rates of stupor/coma, delirium, and no-SCD groups were 42.%, 15.9%, and 12.8%, respectively (p < 0.005). The hazard ratio of the stupor/coma group was 2.79 (CI: 95%, 1.36-5.47, p = 0.005). CONCLUSION: AMS remains a significant clinical challenge in EDs. Using the RASS and 4AT tests provides benefits and advantages for emergency medicine physicians. Neurological, infectious, and respiratory diseases can lead to life-threatening mental deterioration. Our study revealed that long-term mortality predictor CCI scores were quite similar among patients with delirium, stupor, or coma. However, the short-term mortality was significantly increased in the stupor/coma patients and they had 2.8 times higher 30-day mortality risk than others.

[Functionality and everyday suitability of commercially wristwear products for frail older people - a comparative product testing]. / Funktionalität und Alltagstauglichkeit kommerziell erhältlicher Wristwear-Produkte für gebrechliche ältere Menschen : Ein vergleichender Produkttest.

BACKGROUND AND AIM: There is a wide range of smartwatches and emergency watches on the market that are specifically designed for older people. The products are freely available, which is why there is an urgent need for information about the reliability and functionality of the products among potential users, but also health professionals and decision-makers. As part of a systematic product comparison test, the functionality and quality of seven smartwatches were investigated. METHOD: Four watches for seniors, one watch for adults and two watches for children, but with comparable functionalities, were included in the test. For the test, real-life situations were simulated and, in addition to emergency calls, GPS tracking, fall detection and geofencing, the battery life, call quality, stability/robustness of the products and service/support were evaluated. From the total number of points, a grade was determined based on the German school grading system (1 = very good to 6 = insufficient). RESULTS: All smartwatches evaluated were rated at least "3-satisfactory". The two best-rated watches received a score of 1.8. The differences were particularly evident in the emergency call functionality, battery life, precision of the tracking function, and service/support. The call quality, with one exception, and the stability/robustness were consistently rated as "1-very good". Three watches in the test were able to detect falls with variable results. CONCLUSION: The functionality and usability of the tested products differed considerably. A focus on a few main functions can even provide added value for older, frail people. Continuous comparative testing of products for this target group with new and updated products is desirable.

Assessment of the role of neutrophil extracellular traps in SARS-CoV-2 pneumonia.

BACKGROUND: Abnormal neutrophil extracellular traps are associated with lung diseases, thrombosis, increased mucosal secretion in the airways. The aim of this study is to evaluate the possible place of the most specific NETosis marker Cit-H3 protein in diagnostic algorithms by revealing its relationship with the severity, mortality and prognosis of SARS-CoV-2 pneumonia. PATIENTS AND METHODS: Patients (n = 78) who applied to the Emergency Department between March 11, 2020 and June 10, 2020, with positive SARS-CoV-2 polymerase chain reaction (PCR) test and lung involvement were included in the prospective study. Serum Cit-H3 levels and critical laboratory parameters were measured at baseline on the day of clinical deterioration and before recovery/discharge/death. Cit-C3 levels were determined by enzyme immunassay method. RESULTS: Cit-H3 levels in patients with SARS-CoV-2 pneumonia during their first admission to the hospital were significantly higher compared to the healthy control group (p < 0.05). Repeated measurements of Cit-H3 levels of the patients significantly correlated with D-dimer, procalcitonin, Neutrophil/ Lymphocyte ratio, lymphocyte, CRP, and oxygen saturation. Cit-H3 levels of the patients who died were significantly higher than that of those who survived (p < 0.05). Cit-H3 levels were found to be statistically significantly higher in patients who developed acute respiratory distress syndrome, were admitted to the intensive care unit, and had mortality (p < 0.05). CONCLUSIONS: Cit-H3 plays a role in inflammatory processes in SARS-CoV-2 pneumonia, and changes in serum Cit-H3 levels of these patients can be used to determine prognosis and mortality (Tab. 5, Fig. 1, Ref. 21).

ACE2 and ANGII levels in patients with COVID-19 based on thoracic tomography findings and PCR test results.

INTRODUCTION: Reverse transcriptase polymerase chain reaction tests and thoracic tomography have been widely employed in the diagnosis of the disease, but doubts about their sensitivity still persist. Also there are controversial results about ACE2 and AngII levels according to the severity of disease. In this study, we aimed to analyze the ACE2 and AngII levels in patients with suspected COVID-19 based on polymerase chain reaction test results and thoracic tomography findings and to examine their relationship with disease severity. METHODOLOGY: Patients with suspected COVID-19 in the emergency department were divided into 4 groups according to thoracic tomography findings and PCR test results. The in-hospital mortality of patients was recorded. ACE2 and AngII levels in patients were analyzed according to groups and severity of the disease. RESULTS: ACE2 levels for the patients with suspected COVID-19 were significantly lower than in the control group, but AngII levels were higher (not statistically significant). The mean age and male sex ratio of patients who developed acute respiratory distress syndrome (ARDS) and died were significantly higher than those who survived. Whereas there was no difference in ACE2 levels in patients with severe diseases such as ARDS and mortality, their AngII levels were significantly lower. CONCLUSIONS: It can be suggested that decreased ACE2 levels combined with increased AngII levels are determinative at disease onset and in the development of lung damage. However, decreased AngII levels are more determinative in patients with severe diseases such as ARDS and mortality.

Role of plasma angiotensin II and angiotensin-converting enzyme 2 levels on prognosis and mortality in hypertensive patients with COVID-19.

Introduction: SARS-CoV-2 requires angiotensin-converting enzyme 2 (ACE2) to enter the cell. In our study, we aimed to investigate the role of angiotensin-converting enzyme 2 and angiotensin II plasma levels on prognosis and mortality in patients with isolated hypertension, patients with chronic diseases in addition to hypertension and patients with COVID-19 without comorbidities, in accordance with the use of renin-angiotensin-aldosterone system inhibitor. Materials & methods: In the study, patients diagnosed with COVID-19 were divided into three groups. Angiotensin II and ACE2 levels were compared by comorbidities, antihypertensive drugs used, intensive care hospitalization and termination of patients. The relationship between angiotensin II and ACE2 levels and service and intensive care times was investigated. Findings: A total of 218 patients were enrolled in our study, including 68 patients diagnosed with COVID-19 without comorbidities, 33 patients diagnosed with isolated hypertension and 117 patients with other chronic diseases in addition to hypertension. There was no statistically significant difference between the comorbid disease groups between angiotensin II and ACE2 levels of the patients enrolled in the study. The rate of patients admitted to the intensive care unit was 17.9%, and the mortality rate was 11.5%. Results: In our study, we did not obtain significant findings regarding angiotensin II and ACE2 levels on presentation that can be used in prognosis and mortality of COVID-19 patients and development of future treatment methods.

Prognostic importance of serum presepsin level in pneumonia focal sepsis and its relationship with other biomarkers and clinical severity scores.

OBJECTIVES: To analyze the prognostic value of serum presepsin value in community-acquired pneumonia focal sepsis using sepsis-3 criteria and its relationship with other biomarkers and clinical severity scores. METHODS: For this prospective observational study, 176 patients above 18 years old, diagnosed with community-acquired pneumonia, pneumonia focal sepsis and septic shock were included. It was performed in a tertiary hospital between May 2020 and December 2020. Blood samples were obtained from patients for presepsin levels at the time of diagnosis in the emergency room. The serum presepsin levels of 3 groups were statistically compared with each other. RESULTS: The sepsis group had significantly higher serum presepsin levels than the pneumonia group (p=0.004).The septic shock group had serum presepsin levels than sepsis group; however, the difference was not statistically significant (p=0.25). Non survivor patients had significantly higher serum presepsin levels than survivors (p=0.001). Significant correlation determined between serum presepsin level and procalcitonin, C-reactive protein, lactate, pneumonia severity index, and quick sequential organ failure assessment (qSOFA). CONCLUSION: Serum presepsin level is a new biomarker that can be used an indicator of sepsis and mortality in community-acquired pneumonia. However, for determining the prognosis of sepsis, there was no superiority detected over other biomarkers and clinical severity scores.

Accuracy of Ottawa ankle rules for midfoot and ankle injuries.

Background The management of ankle sprains is common practice in emergency departments. Traditionally, physicians would order radiographs for all ankle injuries although the overall incidence of fractures are less than 15% .  The Ottawa Ankle Rules (OAR) have been developed to predict the necessity of radiographs in acute ankle injuries. Material and Method This is a prospective study of consecutive patients aged 16 years or older with acute non-penetrating ankle or foot injuries and who had a radiography of ankle or foot or both. Results 499 cases were included in the study. 56.90 % of the patients were male and the median age of the patients was 30 (IQR  22,44).  22.85 % (114/499) of patients with ankle or midfoot injuries had fractures.  The sensitivity, specificity, PPV and NPV of OAR for ankle and midfoot injuries  were 100, 45.26, 26.00, 100 and 100, 43.71, 19.92 and 100 respectively. In this study 792 x rays were ordered from 499 patients. According to OAR 509  (%64.27) of them were indicated whereas 283 (% 35.73) were not. When the weight bearing test is sole criteria 303 ( 38.26%) x rays were obtained to find out three fractures. Conclusion OAR should be safely used in emergency departments. Implantation of this rule prevents patients from unnecessary radiation exposure. It is a reasonable approach to reassess the patient if symptoms not resolve several days later  for avoiding unnecessary x ray exposure when the weight bearing test exist as the only positive criteria.

Transition from pandemic to infodemic: an analysis of Turkishlanguage COVID-19 YouTube videos.

BACKGROUND: YouTube can be a powerful educational tool for the dissemination of health information. However, if uploaded health-related videos are inaccurate, it can mislead, create confusion and generate panic. AIMS: This study aimed to determine the success of the most-watched Turkish-language COVID-19 YouTube videos regarding information and guidance on the disease for the public. The secondary aim of this study was to evaluate the accuracy and quality of such video content. METHODS: The study was conducted during May 2020 and analysed 133 videos. The length of the videos, the number of likes and dislikes, comments and views, how long they have been on YouTube, Medical Information and Content Index (MICI) Score, mDISCERN scores, global quality scores, and the source and target audiences of the videos were all determined. RESULTS: The average MICI Scores of videos was 2.48±3.74 and the global quality scores was 1.27±0.64. When MICI Scores were compared between video sources, the scores of academic hospitals and government videos were significantly higher. The global quality scores of videos from news agencies and independent users was significantly lower ( < 0.001). The mDISCERN score of the videos uploaded by news agencies and categorized as useful was higher than the others (P < 0.001). Among the targeted videos, only the global quality scores of the videos made for health-care workers were found to be significantly higher. CONCLUSION: Health-care professionals should upload more videos to improve the quality of health-related video content available on YouTube. Accompanied by evidence-based information, the issues of diagnosis, ways of transmission, prevention and treatment of diseases should be emphasized.

Vitamin D Poisoning; Hypercalcemia in a Case with Richter Transformation.

In addition to modern medicine, the search for complementary and alternative medicine has been present for malignancy patients in every period. Confusion, polyuria, polydipsia, anorexia, vomiting, and muscle weakness are symptoms of acute poisoning and are related to hypercalcemia. In our case, a 52-year-old male patient applied to the Emergency Department(ED) with abdominal pain and weakness for two days. In this article, we wanted to present a case with vitamin D poisoning that occurs after the phytotherapy in a patient who developed chronic lymphocytic leukemia (CLL) to Richter transformation. In some patients, especially at ED, taking a high dose of vitamin D history can be challenging. In patients with hypercalcemia, a careful history should be taken, and it should be questioned as "Vitamin D use" rather than "Drug use" since families do not accept the vitamins as drugs.

Comparison of Trauma Severity Scores (ISS, NISS, RTS, BIG Score, and TRISS) in Multiple Trauma Patients.

BACKGROUND: Trauma severity scoring systems are routinely used to monitor trauma patient outcomes. Yet, the most accurate scoring system remains an elusive target. OBJECTIVE: We aim to compare trauma severity scales (ISS, NISS, RTS, TRISS, and BIG) in multitrauma patients and investigate BIG as one of the new trauma severity scoring systems. METHODS: The demographic data of the patients, vital signs, injury mechanisms, body regions exposed to trauma, final diagnosis, the injury severity scales-Injury Severity Score (ISS), New Injury Severity Score (NISS), Revised Trauma Score (RTS), base deficit, international normalized ratio, and Glasgow Coma Scale (BIG), and Trauma and Injury Severity Score (TRISS)-the length of stay in hospital, and the progress of the patients were examined. RESULTS: A total of 426 cases were included in the study. The best performing score in determining mortality was TRISS (area under the curve [AUC]: 0.93, sensitivity 97.1% and specificity 76.7%). This was followed by the NISS, BIG, ISS, and RTS, respectively. For the prediction of intensive care unit admission, the NISS was the most successful with an AUC value of 0.81. There was a significant relationship in terms of the length of stay in all trauma scores (p < .05). CONCLUSIONS: The most successful score in predicting mortality in trauma patients was the TRISS, whereas the NISS was the most successful in predicting intensive care unit admission. The newly developed BIG score can be used as a strong scoring method for predicting prognosis in trauma patients.

Efficacy of Serum Angiotensin II Levels in Prognosis of Patients With Coronavirus Disease 2019.

OBJECTIVES: We aimed to determine serum angiotensin II levels in patients with coronavirus disease 2019 infection and to investigate the effect of these levels on the prognosis of the disease. DESIGN: The study was planned prospectively and observationally. SETTING: The study was conducted in a tertiary university hospital. PATIENTS: Coronavirus disease 2019 patients older than 18 years old, polymerase chain reaction test positive, with signs of pneumonia on tomography, and hospitalized were included in the study. ICU need, development of acute respiratory distress syndrome, and in-hospital mortality were considered as primary endpoints. INTERVENTIONS: Blood samples were taken from patients three times for angiotensin II levels. MEASUREMENTS AND MAIN RESULTS: Angiotensin II levels were studied by enzyme-linked immunosorbent assay method. The SPSS 24.0 program (Statistics Program for Social Scientists, SPSS, Chicago, IL) was used to analyze the data. A total of 112 patients were included in the study, of which 63.4% of the patients were men. The serum angiotensin II levels were statistically significantly lower in the patients with coronavirus disease 2019 compared with the healthy control group (p < 0.001). There was no statistical significance between the serum angiotensin II levels measured at three different times (p > 0.05). The serum angiotensin II levels of the patients with acute respiratory distress syndrome were found to be statistically significantly lower than those without acute respiratory distress syndrome in three samples collected at different clinical periods (p < 0.05). The angiotensin II levels of the patients who required admission to the ICU at all three times of blood sample collection were found to be statistically significantly lower than those who did not (p < 0.05). Although the serum angiotensin II levels of the patients who died were low, there was no statistically significant difference in mortality at all three times (p > 0.05). CONCLUSIONS: The serum angiotensin II levels decrease significantly in patients with coronavirus disease 2019, and this decrease is correlated with lung damage.

The role of plasma presepsin levels in determining the incidence of septic shock and mortality in patients with sepsis.

INTRODUCTION: The present study aimed to investigate the role of plasma presepsin in the early detection of septic shock and in determining the prognosis and mortality of patients with sepsis. METHODOLOGY: The study was conducted in the emergency department between 1 January 2017 and 1 July 2017. A total of 106 patients 18 years of age or older who were diagnosed with sepsis according to the quick sequential organ failure assessment (qSOFA) criteria were included in this prospective study. The patients' symptoms, vital signs, additional diseases, demographic attributes, laboratory results, Mortality in Emergency Department Sepsis (MEDS) scores, imaging findings and treatments were recorded. Moreover, the patients' blood samples were collected to measure plasma presepsin, procalcitonin and CRP levels. RESULTS: In total, 55.7% of the patients were female. The median age of the patients was 78 (24-103) years, and their 30-day mortality rate was 67%. The presepsin level was significantly higher in the sepsis group than in the healthy control group (p < 0.001). The presepsin levels did not differ significantly between the sepsis and septic shock groups (p = 0.12). Similarly, the procalcitonin levels did not differ significantly between the sepsis and septic shock groups (p > 0.05). There was no significant difference in the presepsin, procalcitonin and CRP levels between survivor and non-survivor patients (p = 0.74). CONCLUSIONS: The plasma presepsin level was found to be ineffective in determining the incidence of septic shock and mortality in patients with sepsis in the emergency department.

Chest Computed Tomography Findings of Eight Patients With Covid-19 Diagnosis: Case Series.

COVID-19 is an infectious disease caused by the virus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and declared a pandemic on March 11, 2020, by the world health organization. In Turkey, the first cases began to appear on March 11, 2020. After the cases in China, the appearance of ground glass with or without consolidation in the posterior and periphery of the bilateral lung is determined as the main finding of COVID-19. In this article, we wanted to share the tomography findings of eight patients who were diagnosed with COVID-19 in our emergency department and who had lung involvement.

Comparison of pneumonia severity scores for patients diagnosed with pneumonia in emergency department.

BACKGROUND & OBJECTIVES: : Sepsis due to pneumonia or pneumonia itself is one of the main causes of deaths in patients despite the advanced treatment methods. The optimal prognostic tool in pneumonia is still not clear. This study was aimed to compare the pneumonia severity scores and the possibility of using the new scores in patients who were diagnosed with pneumonia in the emergency department. METHODS: : Demographic data, laboratory and imaging results, confusion, elevated blood urea nitrogen, respiratory rate and blood pressure plus age ≥65 yr (CURB-65), pneumonia severity index (PSI), national early warning score (NEWS), NEWS-lactate (NEWS-L) scores, hospitalization, referral, discharge and 30-day mortality of patients who were diagnosed with pneumonia in emergency department were recorded. RESULTS: : A total of 250 patients were included in the study. The most successful score in predicted mortality was found to be NEWS-L. This was followed by NEWS, CURB-65 and PSI, respectively. Most successful scores in anticipation of admission to the intensive care unit were NEWS-L followed by NEWS. This was followed by CURB-65 and PSI scores, respectively. The most successful score in anticipation of hospital admission was NEWS-L, followed by NEWS, CURB-65 and PSI, respectively. There was a significant difference between all pneumonia severity scores of the patients who died and survived within 30 days. There was a significant difference between the scores of patients in intensive care unit (ICU) and service, compared to non-ICU patients. INTERPRETATION & CONCLUSIONS: : NEWS-L score was found to be the most successful score in predicting mortality, ICU admission and hospitalization requirement. Both NEWS-L and NEWS scores can be used in determining the mortality, need for hospitalization and intensive care of the patients with pneumonia in the emergency department.

Relationship between right ventricular dilatation and blood copeptin levels in patients with acute pulmonary embolism.

PURPOSE: In this study, we aimed to investigate the importance of copeptin in the diagnosis of acute pulmonary embolism, detection of right ventricular dilatation and clinical severity and prognosis of pulmonary embolism. MATERIALS AND METHODS: In the study three groups were created; Group 1: Pulmonary embolism patients with right ventricular dilatation in echocardiography, Group 2: Pulmonary embolism patients without right ventricular dilatation in echocardiography, Group 3: Healthy people. Five mL of venous blood was collected for the measurement of serum copeptin from the patients and control group. D-dimer and troponin were studied with routine blood samples. Complaints, symptom and physical examination findings, tomography and echocardiography results, laboratory results of patients and treatments they received were recorded for the statistical analysis. RESULTS: Copeptin levels of acute pulmonary embolism patients were significantly higher than healthy individuals (P < 0.001). Copeptin values of Group 1 patients were significantly higher than Group 2 patients and Group 3 patients (P < 0.001). There was a statistically significant difference the levels of copeptin, D-dimer and troponin between patients with right ventricular dilatation and patients without right ventricular dilatation (P < 0.05). AUC value in detecting right ventricular dilatation of copeptin was found to be 0.82, while specificity was 83.3% and sensitivity was 69.6%. Copeptin, D-dimer and troponin levels of patients with increased pulmonary artery pressure were statistically significantly higher than patients with normal pulmonary artery pressure (P < 0.05). CONCLUSION: Copeptin can be used in the diagnosis of acute pulmonary embolism and in the detection of right ventricular dilatation in pulmonary embolism.

The role of presepsin in the diagnosis of chronic obstructive pulmonary disease acute exacerbation with pneumonia.

Aim: In this study, we aimed to investigate the role of presepsin in detecting concomitant pneumonia in patients presenting with acute exacerbation of chronic obstructive pulmonary disease (COPD) in the emergency department. Patients & methods: Three groups were formed in the study. Group 1: patients diagnosed with acute exacerbation of COPD; group 2: patients with acute exacerbation of COPD + pneumonia; group 3: healthy individuals. Results: Presepsin levels of the patients in group 2 were significantly higher than those of group 1 and group 3 (p < 0.05). There was a statistically significant difference in erythrocyte sedimentation rate, CRP, procalcitonin and presepsin values between two patient groups (p < 0.05). Conclusion: Presepsin can be used to diagnose pneumonia in patients with acute exacerbation of COPD admitted to the emergency department.

Comparison of ultrasound and physical examination with computerized tomography in patients with blunt abdominal trauma.

BACKGROUND: In cases of blunt abdominal trauma, the abdomen is the third most affected region. Computerized tomography (CT) is the gold standard for the evaluation of these patients. However, considering its damaging effects and high cost, it may not be proper to refer every patient applying to the emergency unit for a CT examination. In this study, our objective was to compare the accuracy of ultrasonography (US) and physical examination in blunt abdominal trauma patients to the gold standard CT in order to prevent unnecessary CT examinations. METHODS: In this retrospective study, the files and images of 2248 patients, who applied to the emergency department of our hospital were screened. A total of 535 adult patients who underwent CT scanning after the ultrasonographic and physical examinations were included in the study. The findings of the US and physical examinations, the intraabdominal free fluid, and organ lacerations were compared to the results of CT. The compatibility, sensitivity, specificity, positive estimated value, and the negative estimated value of the obtained data were analyzed with statistical methods. RESULTS: The sensitivity of US in the demonstration of the intraabdominal free fluid was comparable with the sensitivity of CT in the patients with blunt abdominal trauma (p=0.302). The sensitivity and specificity of US was 49.6% and 99.3% respectively in the determination of the intraabdominal organ injuries. The sensitivity and specificity of the physical examination was 59% and 87% respectively in the determination of the free fluid and organ injury as compared to CT. Although the sensitivity and specificity of the physical examination were high separately in the organ injuries according to the statistical calculations, they seemed not to have had a statistically significant predictive value (p<0.001). CONCLUSION: Even though US is a reliable method for the determination of the intraabdominal fluid, US and physical examination are not reliable in the determination of the organ injuries as compared to CT.

Evaluation of intra-abdominal solid organ injuries in children.

AIM: In our study we investigated characteristics and degree of intra-abdominal solid organ injuries according to tomographic imaging in pediatric patients who presented to our emergency clinic with possible abdominal injuries and to whom US and/or abdominal tomography were applied. MATERIALS AND METHODS: 1066 pediatric patients were included in the study. The age, gender, injury localization, injury type, injury mechanism, abdominal US and CT results, and treatment specifics of patients were evaulated. RESULTS: 58.5% of cases were male. Average age of children was 7.1±4.6 70.8% of the injuries occured in the outdoors. As for injury type, 92.8% of the injuries were blunt and 7.2% were penetrating traumas. The most common mechanism of injury was motor vehicle accidents at 41.4%. The most common abdominal physical examination finding was tenderness with a prevelance of 67%. In patients with solid organ injury, liver injury was detected in 47% of patients, spleen injury was detected in 36% of patients and renal injury was detected in 17% of patients. Grade II injury was the most common grade. 96.5 of patients were provided conservative treatment and 3.5% of patients were treated surgically. CONCLUSION: Solid organ injuries due to abdominal trauma in children are generally related to blunt trauma and are severe injuries. CT angio is an important imaging method for detecting solid organ injuries, classification of the injury and treatment determination. Greater than 90% of solid organ injuries in children can be treated successfully with conservative methods.

Endosulfan induced cardiac arrest treated with intravenous lipid emulsion.

OBJECTIVE: Endosulfan is an organochlorine pesticide with high lipophilic features that makes it a well-absorbed agent and penetrates easily to the site of action. Endosulfan toxicities may result in disastrous complications and have high rates of mortality. Several case reports and some researchs discuss the evidence supporting intravenous lipid emulsion (ILE) therapy as a rescue therapy in lipophilic agents' toxicity. CASE REPORT: A 33-years-old healthy woman with  a history of endosulfan ingestion of uncertain quantity in a suicide attempt six hours ago was admitted to our emergency department. Cardiac arrest ensued after one hour of admission. Cardiopulmonary resuscitation was initiated in accordance with advanced cardiac life support (ACLS) algorithm for asystole. During resuscitation, 2 mL/kg bolus of 20% intravenous lipid emulsion (ILE) was administered for three times at five-minute intervals in addition to ACLS guidance. Spontaneous circulation returned after twenty minutes of resuscitation. No additional antidotal or vasopressor therapies were required during the hospital course of the patient. To our knowledge, this is the first reported case with responded use of ILE treatment for endosulfan toxicity. CONCLUSION: This case report indicates that ILE treatment should be considered for life-threatening endosulfan intoxications.